What is symphysis pubis dysfunction?

The symphysis pubis is a stiff joint that connects the two halves of your pelvis. This joint is strengthened by a dense network of tough, flexible tissues (ligaments). Your body produces a hormone called relaxin, which softens your ligaments in order to help your baby pass through your pelvis.

Your pelvic joints move more during and just after pregnancy (Bjorkland et al 1999, Bjorkland et al 2000, Kristiansson 1997, Vollestad et al 2012). This can cause inflammation and pain, and may lead to the condition symphysis pubis dysfunction (SPD).

Diastasis symphysis pubis (DSP) is similar to SPD. This is when the gap in the pubic joint widens too far. The average gap between the bones in a non-pregnant woman is between 4mm and 5mm. During pregnancy it's normal for this gap to widen by 2mm or 3mm. If the gap is 10mm or more, DSP is diagnosed. It's rare, and can only be identified by X-ray (Parker & Bhattacharjee 2009).

What are the symptoms of SPD?

Pain in the pubic area and groin are the most common symptoms, though you may also have the following signs:

Pain down the inside of your thighs or between your legs. It can be made worse by parting your legs, walking, going up or down stairs or moving around in bed.

Worse pain at night. SPD can prevent you from sleeping well. Getting up to go to the toilet in the middle of the night can be especially painful.

What causes SPD?

SPD is thought to be caused by a combination of hormones that you produce during pregnancy, as well as the way your body moves. If one side of your pelvis moves more than the other when you walk or move around, the area around the symphysis pubis becomes tender (Buyruk et al 1999, Damen et al 2001, Vleeming et al 2005).

The size of the gap in your joint doesn't bear any relation to the amount of pain you may feel. Many women with a normal-sized gap feel a lot of pain.

You may be more likely to develop SPD if you started your periods before you were 11, or are overweight (Clark C 2010, Dennison et al 2009, Bjelland et al 2011).

When does SPD happen?

SPD can occur at any time during your pregnancy or after giving birth (Keriakos et al 2011). You may notice it for the first time during the middle of your pregnancy.

If you have SPD in one pregnancy, it is more likely that you'll have it next time you get pregnant (Bjelland et al 2010, Shephered 1997, Snow 1997). The symptoms may also come on earlier and progress faster, so it is important to seek help promptly. It can help if you allow the symptoms from one pregnancy to settle before trying to get pregnant again.

How is SPD diagnosed?

SPD is becoming more widely understood by doctors, physiotherapists and midwives. Your doctor or midwife should refer you to a women's health physiotherapist.

How is SPD treated?

Exercises, especially focused on your tummy and pelvic floor muscles. These will improve the stability of your pelvis and back (Richardson et al 2002, Van Wingerden et al 2004, Vleeming et al 2005). You may need gentle, hands-on treatment of your hip, back or pelvis to correct stiffness or imbalance. Exercise in water can sometimes help.

You should also be given advice on how to make daily activities less painful and on how to make the birth of your baby easier. Your midwife should help you to write a birth plan which takes into account your SPD symptoms.

How can I help to ease my pain?

Do pelvic floor and tummy exercises. Get down onto your hands and knees and level your back so that it is roughly flat. Breathe in and then as you breathe out, squeeze in your pelvic floor muscles and pull your belly button in and up. Hold this contraction for between five and 10 seconds, breathing through it. Relax your muscles slowly at the end of the exercise.

Try not to move your legs apart when your back is slumped or when you are lying down. Take care when getting in and out of the car, bed or bath. If you are lying down, pull your knees up as far as you can to stop your pelvis from moving and make it easier to part your legs. If you are sitting, try arching your back and sticking your chest out before parting or moving your legs.

Don't push through your pain. If something hurts, stop doing it. If the pain is allowed to flare up, it can take a long time to settle down again.

Move little and often. You may not feel the effects of what you are doing until later in the day or after you have gone to bed.

Rest regularly by sitting on a birth ball or by getting down on your hands and knees. This takes the weight of your baby off your pelvis and holds it in a stable position.

Try not to do heavy lifting or pushing. Supermarket trolleys can often make your pain worse, so shop online or ask someone to shop for you.

When climbing stairs, take one step at a time. Step up onto one step with your best leg and then bring your other leg to meet it. Repeat with each step.

Avoid swimming breaststroke and take care with other strokes. You may feel swimming is helping your pain while you are in the water, but it could make you feel worse when you get out.

When getting dressed, sit down to pull on your knickers or trousers.

Will I recover from SPD after I've had my baby ?

You're very likely to recover after your baby is born (Owens et al 2002). If you can, carry on with physiotherapy after the birth. Try to get help with looking after your baby during the early weeks.

You may find you get twinges every month just before your period is due. This is caused by hormones that have a similar effect to the pregnancy hormone relaxin.

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Comments

Im 31 weeks now and experiencing SPD since week 28. I have this in between Leg pain, and muscles cramps every morning I wake up. This is hard coz i havent experienced it with my last pregnancies. It hurts, and i cant move freely, and cant even walk as much as I want.

I wasn't offered induction due to SPD and wouldnt have gone down that route
If I was. I found that natural labour and birth in a birthing pool with just gas and air worked for me both times as I could control my position to minimise the pressure on my pelvis. I'm now 28 weeks into my 4th pregnancy (3rd baby) and ive suffered SPD from 9 weeks. this time im planning a home water birth, again just so I can control my own position. I know this isn't an option for everyone but I found that being in so much pain throughout pregnancy meant labour for me was relatively easy and dare i say it enjoyable as it signified the end of the pain. Good luck everyone with this condition and it doesnt automatically mean a difficult labour is on the cards x

i am 34 weeks and have just started experiencing SPD , i hope with the help of this article i just read i will be able to control mine or possibly stop the pain before its gets worse .this is my first pregnancy and i hope every thing goes on successfully

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